Advancing the m-learning research agenda for active, experiential learning: Four case studies

This article reports on an m-learning research agenda instituted at our university in order to explore how mobile technology can enhance active, experiential learning. Details of the implementation and results of four areas of m-learning are presented: mobile supported fieldwork, fostering interactivity in large lectures with mobile technology, using mobile devices to learn about mobile technology and, finally, podcasting. These directions are informed by a concern for achieving m-learning practices consistent with sound educational theory and the needs of the contemporary, technologically aware student body. All four implementations have been successfully embedded in mainstream subjects on a continuing basis. Therefore they represent a departure from the project based approach of much m-learning reported in the literature. This outcome was achieved through a focus on the economic sustainability and feasibility of each case. An evaluation focusing on how well each case assisted students' learning found that, with the exception of lecture podcasting, all supported high quality experiential learning

Resolving the nucleus of Centaurus A at mid-IR wavelengths

We have observed Centaurus A with the MID-infrared Interferometric instrument (MIDI) at the Very Large Telescope Interferometer (VLTI) at resolutions of 7 - 15 mas (at 12.5 micron) and filled gaps in the (u,v) coverage in comparison to earlier measurements. We are now able to describe the nuclear emission in terms of geometric components and derive their parameters by fitting models to the interferometric data. With simple geometrical models, the best fit is achieved for an elongated disk with flat intensity profile with diameter 76 +/- 9 mas x 35 +/- 2 mas (1.41 +/- 0.17 pc x 0.65 +/- 0.03 pc) whose major axis is oriented at a position angle (PA) of 10.1 +/- 2.2 degrees east of north. A point source contributes 47 +/- 11 % of the nuclear emission at 12.5 micron. There is also evidence that neither such a uniform nor a Gaussian disk are good fits to the data. This indicates that we are resolving more complicated small-scale structure in AGNs with MIDI, as has been seen in Seyfert galaxies previously observed with MIDI. The PA and inferred inclination i = 62.6 +2.1/-2.6 degrees of the dust emission are compared with observations of gas and dust at larger scales.Comment: Accepted for the PASA special issue on Centaurus

Ammonia (J,K) = (1,1) to (4,4) and (6,6) inversion lines detected in the Seyfert 2 galaxy NGC 1068

We present the detection of the ammonia (NH3) (J,K) = (1,1) to (4,4) and (6,6) inversion lines toward the prototypical Seyfert 2 galaxy NGC 1068, made with the Green Bank Telescope (GBT). This is the first detection of ammonia in a Seyfert galaxy. The ortho-to-para-NH3 abundance ratio suggests that the molecule was formed in a warm medium of at least 20 K. For the NH3 column density and fractional abundance, we find (1.09\pm0.23)\times10^14 cm^-2 and (2.9\pm0.6)\times10^-8, respectively, from the inner 1.2 kpc of NGC 1068. The kinetic temperature can be constrained to 80\pm20 K for the bulk of the molecular gas, while some fraction has an even higher temperature of 140\pm30 K.Comment: 5 pages, 3 figures, accepted by A&

Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry

Aims To determine clinical correlates and optimal treatment strategy in patients with cardiogenic shock (CS) on admission. Methods and results In SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? (SHOCK) trial and registry patients with left ventricular (LV) dysfunction (n=1053), CS on admission occurred in 26% of directly admitted patients (n=166/627). Time from myocardial infarction to CS was shorter, initial haemodynamic profile poorer, and aggressive treatment less frequent in CS on admission than in delayed CS patients. CS on admission patients constituted a smaller relative proportion (11%) of the transferred (n=48/426) when compared with the directly admitted cohort (P<0.001). In-hospital mortality was higher (75 vs. 56%; P<0.001) with more rapid death (24-h mortality 40 vs. 17%; P<0.001) in CS on admission than in delayed CS patients. Emergency revascularization reduced in-hospital mortality in CS on admission (60 vs. 82%; P=0.001) and in delayed CS patients similarly (46 vs. 62%; P<0.001; interaction P=0.25). After adjustment for clinical differences, CS on admission was an independent predictor of in-hospital mortality (P=0.008). Conclusion CS on admission patients have a worse outcome but benefit equally from emergency revascularization as delayed CS patients, emphasizing the need for rapid and direct access of CS on admission patients to facilities providing this car

Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India

Background: Rapid urbanization in low- and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups. Objective: The study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups. Design: A mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers. Results: The mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected. Conclusions: The rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holistic understanding of urban health. In order to derive evidence-based solutions and interventions, routine surveillance data become indispensable

Gas dynamics of the central few parsec region of NGC 1068 fuelled by the evolving nuclear star cluster

High resolution observations with the NIR adaptive optics integral field spectrograph SINFONI at the VLT proved the existence of massive and young nuclear star clusters in the centres of a sample of Seyfert galaxies. With the help of three-dimensional high resolution hydrodynamical simulations with the Pluto code, we follow the evolution of such clusters, focusing on stellar mass loss. This leads to clumpy or filamentary inflow of gas on large scales (tens of parsec), whereas a turbulent and very dense disc builds up on the parsec scale. In order to capture the relevant physics in the inner region, we treat this disc separately by viscously evolving the radial surface density distribution. This enables us to link the tens of parsec scale region (accessible via SINFONI observations) to the (sub-)parsec scale region (observable with the MIDI instrument and via water maser emission). In this work, we concentrate on the effects of a parametrised turbulent viscosity to generate angular momentum and mass transfer in the disc and additionally take star formation into account. Input parameters are constrained by observations of the nearby Seyfert 2 galaxy NGC 1068. At the current age of its nuclear starburst of 250 Myr, our simulations yield disc sizes of the order of 0.8 to 0.9 pc, gas masses of 1.0e6 solar masses and mass transfer rates of 0.025 solar masses per year through the inner rim of the disc. This shows that our large scale torus model is able to approximately account for the disc size as inferred from interferometric observations in the mid-infrared and compares well to the extent and mass of a rotating disc structure as inferred from water maser observations. Several other observational constraints are discussed as well.Comment: 13 pages, 11 figures, accepted for publication in MNRAS, updated author list and reference

Associations between double-checking and medication administration errors: A direct observational study of paediatric inpatients

Background Double-checking the administration of medications has been standard practice in paediatric hospitals around the world for decades. While the practice is widespread, evidence of its effectiveness in reducing errors or harm is scarce. Objectives To measure the association between double-checking, and the occurrence and potential severity of medication administration errors (MAEs); check duration; and factors associated with double-checking adherence. Methods Direct observational study of 298 nurses, administering 5140 medication doses to 1523 patients, across nine wards, in a paediatric hospital. Independent observers recorded details of administrations and double-checking (independent; primed-one nurse shares information which may influence the checking nurse; incomplete; or none) in real time during weekdays and weekends between 07:00 and 22:00. Observational medication data were compared with patients' medical records by a reviewer (blinded to checking-status), to identify MAEs. MAEs were rated for potential severity. Observations included administrations where double-checking was mandated, or optional. Multivariable regression examined the association between double-checking, MAEs and potential severity; and factors associated with policy adherence. Results For 3563 administrations double-checking was mandated. Of these, 36 (1·0%) received independent double-checks, 3296 (92·5%) primed and 231 (6·5%) no/incomplete double-checks. For 1577 administrations double-checking was not mandatory, but in 26·3% (n=416) nurses chose to double-check. Where double-checking was mandated there was no significant association between double-checking and MAEs (OR 0·89 (0·65-1·21); p=0·44), or potential MAE severity (OR 0·86 (0·65-1·15); p=0·31). Where double-checking was not mandated, but performed, MAEs were less likely to occur (OR 0·71 (0·54-0·95); p=0·02) and had lower potential severity (OR 0·75 (0·57-0·99); p=0·04). Each double-check took an average of 6·4 min (107 hours/1000 administrations). Conclusions Compliance with mandated double-checking was very high, but rarely independent. Primed double-checking was highly prevalent but compared with single-checking conferred no benefit in terms of reduced errors or severity. Our findings raise questions about if, when and how double-checking policies deliver safety benefits and warrant the considerable resource investments required in modern clinical settings

A randomised controlled trial of high vs low volume initiation and rapid vs slow advancement of milk feeds in infants with birthweights 1000 g in a resource-limited setting

Background: Optimal feeding regimens for infants ≤ 1000 g have not been established and are a global healthcare concern. Aims and objectives: A controlled trial to establish the safety and efficacy of high vs low volume initiation and rapid vs slow advancement of milk feeds in a resource-limited setting was undertaken. Methods: Infants ≤ 1000 g birthweight were randomised to one of four arms, either low (4 ml/kg/day) or high (24 ml/kg/day) initiation and either slow (24 ml/kg/day) or rapid (36 ml/kg/day) advancement of exclusive feeds of human milk (mother’s or donor) until a weight of 1200 g was reached. After this point, formula was used to supplement insufficient mother’s milk. The primary outcome was time to reach 1500 g. Results: infants were recruited (51: low/slow; 47: low/rapid; 52: high/slow; 50: high/rapid). Infants on rapid advancement regimens reached 1500 g most rapidly (hazard ratio 1.48, 95% CI 1.05–2.09, P=0.03). The rapid advancement groups also regained birthweight more rapidly (hazard ratio 1.77, 95% CI 1.26–2.50, P=0.001). There was no apparent effect of high vs low initiation volumes but there was some evidence of interaction between interventions. There were no significant differences in other secondary outcomes, including necrotising enterocolitis, feed intolerance and late-onset sepsis. Conclusions: In this small pilot study, higher initiation feed volumes and larger daily increments appeared to be well tolerated and resulted in more rapid early weight gain. These data provide justification for a larger study in resource-limited settings to address mortality, necrotising enterocolitis and other important outcomes